Sightsavers Deworming Program – Cameroon GiveWell Wishlist 3 Schistosomiasis (SCH) / Soil Transmitted Helminth (STH) Project Narrative Country: Cameroon Location (region/districts): South-West, North-West, West, Far North, North, Littoral, East, Adamaoua Duration of project: 3 years Start date: April 2019 Goal Reduction in the prevalence and intensity of SCH and STH amongst school age children. Outcome School aged children (SAC) between 5 -15 years, and adults where prevalence dictates, within the intervention zone are effectively treated with mebendazole/albendazole and praziquantel as required. Program implementation areas Sightsavers is supporting SCH / STH mass drug administration (MDA) in three regions of South West, North West and West Cameroon in 2018 with funding from GiveWell’s quarterly payments. Wishlist 3 will extend this support in existing implementation areas for an additional two years to help control SCH and STH in compliance with the National NTD Program policies. We have divided the Wishlist 3 funding request into three priorities that constitute a nationwide program. Sightsavers will only expand cumulatively, i.e. each consecutive priority builds upon the ask of the previous priority. Priority 1: SCH/STH MDA in our existing operational regions of West, North-West, and South- West. Our current approach of using GiveWell’s quarterly allocations is not sustainable. The funding available through quarterly allocations varies. To enable a well-planned program we need secured funding to ensure resources are allocated appropriately. We therefore request grant funding to continue implementation of the SCH/STH program in the West, North-West and South- West regions from April 2019 – Mar 2022. Priority 2: SCH/STH MDA in North and Far North regions The two northern regions are the second priority because Sightsavers’ staff on the ground work in collaboration with HKI to support the MoH in the implementation of the trachoma programme (SAFE activities). Sightsavers’ presence in these regions and our existing relationship with HKI means implementation of SCH/STH MDA would be feasible. Priority 3: SCH/STH MDA in Adamaoua, East and Littoral (the remaining three regions requiring funding). Funding these three regions would complete the nationwide program. Sightsavers does not currently work in these regions, but could coordinate a national-scale program through the NGO coordination group1 of which we are a member. Sightsavers would then work in synergy with members of this group, key NTD policy makers and the national NTD control program. Table to show prevalence and treatment schedule in program implementation areas Region / SCH SCH STH STH Total Total SAC3 District prevalence* treatment prevalence* treatment population schedule schedule 20192 North-West Ako 86.00% Annual + adult 14.00% Not required 48,312 12,078 Bafut 2.00% Every 3 years 68.00% Annual 53,524 13,381 Bali 0.00% Not required 12.00% Not required 27,376 6,844 Bamenda 2.00% Every 3 years 6.00% Not required 290,344 72,586 Batibo 0.00% Not required 82.00% Annual 82,230 20,558 Benakuma 4.00% Every 3 years 22.40% Annual 53,411 13,353 Fundong 0.00% Not required 22.00% Annual 123,785 30,946 Kumbo East 12.00% Annual 12.20% Not required 134,932 33,733 Kumbo West 0.00% Not required 40.00% Annual 93,372 23,343 Mbengwi 0.00% Not required 12.50% Not required 46,203 11,551 Ndop 0.00% Not required 84.00% Annual 207,200 51,800 Ndu 10.00% Annual 8.20% Not required 88,615 22,154 Njikwa 0.00% Not required 10.00% Not required 23,284 5,821 Nkambe 2.00% Every 3 years 58.00% Annual 119,463 29,866 Nwa 0.00% Not required 58.00% Annual 69,521 17,380 Oku 0.00% Not required 40.00% Annual 85,515 21,379 Santa 2.00% Every 3 years 50.00% Annual 88,008 22,002 Tubah 0.00% Not required 4.10% Not required 52,515 13,129 Wum 6.00% Every 3 years 64.00% Annual 110,956 27,739 South-West Akwaya 0.00% Not required 48.89% Annual via LF 63,995 15,999 Bakassi 0.00% Not required 59.20% Annual 7,016 1,754 Bangem 0.00% Not required 16.00% Not required 22,518 5,630 Buea 38.00% Annual 41.70% Annual 98,704 24,676 Ekondo Titi 82.00% Annual + adult 94.00% Annual 67,192 16,798 Eyumojock 2.00% Every 3 years 42.20% Annual 42,156 10,539 Fontem 0.00% Not required 84.00% Annual 74,027 18,507 Konye 8.30% Every 3 years 83.30% Annual 66,554 16,639 Kumba 47.50% Annual 73.90% Annual 307,625 76,906 Limbe 0.00% Not required 47.90% Annual 148,039 37,010 Mamfe 0.00% Not required 56.00% Annual 82,579 20,645 Mbongue 82.00% Annual + adult 22.00% Annual 81,917 20,479 Mundemba 0.00% Not required 35.30% Annual 21,527 5,382 Muyuka 78.00% Annual + adult 16.00% Not required 94,391 23,598 1 This consortium of NGOs emerged 1996 to enhance collaboration with the government in coordinating NTDs activities. 2 Based on population projections 3 Based on estimated 25% of population Nguti 18.00% Annual 26.00% Annual 34,741 8,685 Tiko 0.00% Not required 21.30% Annual 126,224 31,556 Tombel 0.00% Not required 64.00% Annual 64,420 16,105 Wabane 0.00% Not required 84.00% Annual 49,223 12,306 West Bafang 2.00% Every 3 years 30.00% Annual 107,992 26,998 Baham 1.00% Every 3 years 18.00% Not required 57,874 14,469 Bamendjou 0.00% Not required 0.00% Not required 49,345 12,336 Bandja 1.00% Every 3 years 20.40% Annual 37,444 9,361 Bandjoun 0.00% Not required 18.40% Not required 125,323 31,331 Bangangte 1.00% Every 3 years 22.40% Annual 102,036 25,509 Bangourain 1.00% Every 3 years 16.00% Not required 40,335 10,084 Batcham 1.00% Every 3 years 14.60% Not required 93,255 23,314 Dschang 0.00% Not required 26.50% Annual 238,987 59,747 Foumban 10.00% Annual 4.00% Not required 193,060 48,265 Foumbot 30.00% Annual 8.00% Not required 94,872 23,718 Galim 29% Annual 14.00% Not required 58,494 14,624 Kekem 7.00% Every 3 years 42.90% Annual 42,886 10,722 Kouoptamo 41.00% Annual 2.00% Not required 81,439 20,360 Malentouen 96.00% Annual + adult 20.50% Annual 171,886 42,972 Massangam 5.00% Every 3 years 9.30% Not required 50,766 12,692 Mbouda 1.00% Every 3 years 14.90% Not required 194,700 48,675 Mifi 1.00% Every 3 years 13.80% Not required 342,499 85,625 Penka Michel 1.00% Every 3 years 34.80% Annual 90,802 22,701 Santchou 0.00% Not required 22.00% Annual 31,746 7,937 Total 5,457,155 1,352,219 * An impact survey undertaken during 2018 reassessed the prevalence of SCH and STH in the South-West, North- West and West. Project implementation will be based on these updated prevalence figures and their associated treatment schedule. Prevalence and treatment strategy GiveWell’s continued support will enable SCH and STH MDA in accordance with the WHO- defined minimum thresholds for MDA eligibility. In the case of SCH, we will implement MDA activities by meeting, or where the MoH deem it necessary, by intensifying the WHO-defined treatment strategies. In the case of Cameroon, please see the table below. SCH endemicity Cameroon MoH WHO strategy4 High risk (≥50%) Treat SAC every year Treat SAC every year Moderate (≥10 but <50%) Treat SAC every year Treat SAC once every two years Treat SAC twice during their primary Treat SAC once every three Low (≥0 but < 10%) schooling years years (every three years) Adult treatment, which is recommended by WHO in areas of high SCH prevalence (> 50%), is required as part of this program. 4 Helminth control in school age children: a guide for managers of control programmes, Second edition, 2011, page 74-75 Please see the attached spreadsheet, ‘Prevalence and treatments Wishlist 3’, for the full prevalence detail and treatment targets by district. Outputs Output 1: Train health workers, teachers and community members to deliver SCH/STH MDA to schools and endemic communities. Output 2a: Treat school aged children between 5-15 years for SCH/STH MDA. Output 2b: Treat adults for SCH/STH through MDA where prevalence rates dictate. Output 3: Ministry of Health coordinates and supports targeted regions/districts to implement the National NTD Plan with focus on SCH/STH. Key output indicator targets Priority 1: Year 25 Year 3 Year 4 Apr’19 – Mar‘20 Apr’20 – Mar‘21 Apr’21 – Mar’22 Number of teachers trained on SCH/STH MDA 8,546 6,016 6,072 Number of health workers trained on SCH/STH 983 983 983 MDA Number of CDDs trained on SCH/STH MDA 1,548 1,548 1,548 Number of children aged children between 5- 596,758 612,273 628,193 15 years treated for STH Number of children aged children between 5- 663,972 299,370 307,154 15 years treated for SCH Number of adults treated for STH - - - Number of adults treated for SCH 154,566 158,586 162,708 Priority 2: additional to priority 1 Year 2 Year 3 Year 4 Apr’19 – Mar‘20 Apr’20 – Mar‘21 Apr’21 – Mar’22 Number of teachers trained on SCH/STH MDA 7,964 5,069 5,069 Number of health workers trained on SCH/STH 1,512 1,512 1,512 MDA Number of CDDs trained on SCH/STH MDA - - - Number of children aged children between 5- 1,088,713 1,117,020 1,146,062 15 years treated for STH Number of children aged children between 5- 1,035,008 231,319 237,333 15 years treated for SCH Number of adults treated for STH - - - Number of adults treated for SCH - - - 5 Year 1 considered to be 2018 MDA funded by GiveWell quarterly grants Priority 3: additional to priorities 1 & 2 Year 2 Year 3 Year 4 Apr’19 – Mar‘20 Apr’20 – Mar‘21 Apr’21 – Mar’22 Number of teachers trained on SCH/STH MDA 6,171 3,604 3,604 Number of health workers trained on SCH/STH 710 710 710 MDA Number of CDDs trained on SCH/STH MDA 869 869 869 Number of children aged children between 5- 376,273 386,056 376,273 15 years treated for STH Number of children aged children between 5- 883,256 334,230 342,920 15 years treated for SCH Number of adults treated for STH - - - Number of adults treated for SCH 86,838 89,096 91,413 Please see attached ‘Combined Wishlist 3 logframe’ for full outputs, outcomes, impact and associated risks and assumptions.